Kyle L Wagamon, MD

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

35083746 Issued in OH

Practice address

1745 Niles Cortland Rd NE Ste 5
Warren, OH 44484-6046

Phone

(330) 856-6365

Fax

(330) 474-3981

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

DermatologyAlso: Pathology

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Warren Dermatology and Mohs Surgery LLCGroup PAC ID 8628384070, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• MH St Joseph Warren Hospital Hospital, Warren, OH, CCN 360161
• MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wagamon-kyle@2ec72f95.micromddirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Warren Dermatology and Mohs Surgery LLC.

  • Dermatology Physician
  • Warren, OH
  • NPI 1033591813
  Medicare reassignment Care Compare group NPD
• Dermatology West, LLC

  • Clinic/Center
  • Westlake, OH
  • NPI 1053521021
  NPD (past) Authorized official
• Ohio Medical Specialists, LLC

  • Dermatology Physician
  • Warren, OH
  • NPI 1902285943
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mercy Health Youngstown LLC

  • Clinical Medical Laboratory
  • Warren, OH
  • NPI 1538233309

  Hospital

  Care Compare affiliation
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1548296106
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Warren, OH
  • NPI 1629009964
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • Clinical Medical Laboratory
  • Youngstown, OH
  • NPI 1831600295

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774569600000",
    "number": "1780758003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19301 CYCLONE DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441351731",
            "telephone_number": "330-393-4000",
            "fax_number": "330-392-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1745 NILES CORTLAND RD NE STE 5",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444846046",
            "telephone_number": "330-856-6365",
            "fax_number": "330-474-3981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2660 E Market St",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "OH",
            "postal_code": "444836204",
            "country_code": "US",
            "telephone_number": "330-393-4000",
            "fax_number": "330-392-5870",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGAMON",
        "first_name": "KYLE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2026-03-27",
        "certification_date": "2026-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OH",
            "license": "35083746",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "OH",
            "license": "35083746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7474933",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON",
            "identifier": "000000217451",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00406585",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "415051",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000527821",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2754827",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE",
            "identifier": "748956",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Neera Nitin Vora
• Denise Marie Voytko, NP
• Pamela L Waddell, LPCC
• Randi Jean Wadlow
• Rayann Wadolowski, LPN
• Emily Wagner, CDCA
• Eriana Tiara Marie Wagner
• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co

• Dermatopathology Physician in Warren, OH
• Providers in Warren, OH by specialty
• Dermatopathology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.